As the disease progresses, symptoms appear that indicate an infectious process associated with the presence of cerebral and focal lesions.
Acute disseminated encephalomyelitis
The disease often occurs in children and adolescents. In the early stages of development, it is necessary to differentiate it from multiple sclerosis. The main condition for determining the diagnosis is the absence of signs of demyelination before the current episode (except for relapse).
Characterizes disseminated encephalomyelitis by the formation of areas of inflammation in different parts of the spinal and brain parts of the brain. The disease proceeds in an acute form – it develops quite quickly and, depending on the cause, which caused it, the nature of the process, the treatment started in a timely manner, ends with recovery, paralysis or death.
For a long time it was believed that a disease of the disseminated type appears only once, but the researchers concluded that the probability of a relapse. They appear in demyelination, as well as the appearance of new signs. In the latter case, they speak of multiphase acute disseminated encephalomyelitis. When repeated attacks on the myelin sheath – on the return of the OREM. The latter form occurs most often. The number of relapses reaches four, and some of them appear after long episodes of remission.
Localization of the disease allows you to select several of its types:
- Encephalomyelopraradiculitis. Characterized by the defeat of all parts of the central nervous system.
- Polyencephalomyelitis. Inflammation occurs predominantly in the gray matter.
- Opticoencephalomyelitis. The lesion includes the optic nerves.
- Disseminated. Small foci are found in different parts of the central nervous system.
Read also … How inflammation of the optic nerve manifests itself: characteristic symptoms, treatment and prognosis
With the development of an independent disease they speak of a primary form. Disseminated encephalomyelitis resulting from another pathology is secondary.
The pathogenesis is similar to multiple sclerosis. Under the influence of an infection, the myelin sheath of neurons is destroyed. Its main function is the transmission of nerve impulses. Consists mainly of protein and lipids.
Under the influence of an infectious factor or vaccine, T-lymphocytes and immunoglobulin are activated, they penetrate the blood-brain barrier, promote the formation of antigens that act against the myelin sheath. Its proteins are perceived by the body as alien, having a pathological character.
As a result, swelling, swelling of myelin, its disintegration and disappearance under the influence of phagocytes appear. In place of the missing neurons, glial tissue eventually grows. The long processes of neurons, axons, while not suffering.
The basis of the development of acute disseminated encephalomyelitis are viral, bacterial infections. In some cases, the disease has a post-vaccination etiology. In about 30% of cases, it is caused by the human acute encephalomyelitis virus.
The viruses that cause it include: measles, chicken pox, mumps, herpes, influenza, Coxsackie, HIV, cytomegaloviurs. Myalgic encephalomyelitis has a viral nature.
There is a disease due to the introduction of a vaccine against diphtheria, chicken pox, tetanus, mumps, polio. It also occurs after rabies vaccination.
Disseminated encephalomyelitis develops in 0.1% of patients who have received a vaccine, and accounts for only 5% of the patients. An important precipitating factor is not an infection, but the tissues of the central nervous system contained in the injected preparation.
Less commonly noted is the bacterial nature of the disease. The bacteria mycoplasma, chlamydia, streptococcus, borellia, and leptospirosis lead to it.
Most scientists are inclined to believe that bacteria, viruses and vaccines only provoke disseminated encephalomyelitis. Genetic predisposition is necessary for the development of the disease.
Among the factors that facilitate its appearance, stress, heavy physical exertion, and children’s age are noted.
At the initial stages of the development of acute disseminated encephalomyelitis, manifestations of a common infectious disease are observed: the temperature rises, pain appears in the head, muscles, the patient begins to feel sick.
Within a few days, neurological symptoms appear and increase. Separately separate cerebral and focal character scattered encephalomyelitis lesions.
In the acute period, the most cerebral symptoms are most pronounced. At this time it is difficult to distinguish them from signs of other diseases, such as multiple sclerosis.
Appears vomiting, not associated with eating and not alleviating the patient’s condition. Convulsive phenomena that resemble epileptic seizures occur – a person loses consciousness, his body stretches into a string, shudders.
Children often have a disorder of consciousness. They faint, which sometimes goes into a coma. The appearance of hallucinations, delusions, feelings of stupidity.
The muscles of the neck become rigid. Patients keep their head in one position, they can not move it. Brudzinsky syndrome is observed – when pulling the chin to the chest, involuntary bending of the knees occurs.
Many people experience serious psycho-emotional problems, show a tendency to depression, sharp mood swings.
Neurological status is complemented by signs of damage to the pyramidal system. There is complete immobility of the limbs. This symptom occurs in more than 75% of cases.
Paralysis is noted in different areas – its location depends on the location of the site of inflammation.
Among other symptoms are noted:
- Ataxia. Violation of coordination of movements with intact muscle strength. The patient does not fulfill the request to bring a finger to his nose.
- Arbitrary eye movements. There are trembling, gaze turned in one direction.
- Vision disorders. Observed in about 30% of cases. Reduced sharpness, breadth. Double vision arises, a veil of fog is lining up before my eyes. In rare cases, complete blindness is possible.
- Speech disorders. It becomes blurred, unintelligible. A person loses the ability to choose words, cannot express what he wanted to say.
- Decreased sensitivity. There is a burning sensation, numbness, crawling. A person loses the ability to feel a touch, hot, cold.
- Disturbance of swallowing. Often the patient cannot swallow.
- Fatigue Patients get tired even after a small load.
In the vast majority of people suffering from disseminated encephalomyelitis, the symptoms disappear after a few weeks. Predict relapse is not possible. However, in some cases, three months after the disappearance of signs of the disease, they may reappear. If new symptoms of encephalomyelitis do not appear, and an increase in old lesions is detected on an MRI scan, they indicate a return form. Relapse occurs a month after the cancellation of hormone therapy.
In the same period of time, multiphase disseminated encephalomyelitis progresses. New clinical signs appear, new areas of inflammation are detected on MRI. The old ones disappear.
According to the results of the data obtained after magnetic resonance imaging, a person suffering from disseminated encephalomyelitis, a large number of asymmetric lesions with poorly defined edges of different sizes. They are located mainly in the white brain. Less common is one large affected area. Quite often foci are found in gray matter. They are found in the visual nucleus, subcortical nuclei, in rare cases – in the corpus callosum.
In addition to foci of inflammation of a small size, there are large areas, merging, resembling tumors, less often – with hemorrhages.
The prognosis of the disease does not depend on the clinical picture. In most cases, the swelling subsides, lost functions are restored.
In about a quarter of patients, demyelination sites are found in the spinal cord. They are located mainly in the thoracic region, often characterized by a large size.
To determine the correct diagnosis, objective signs, subjective sensations, analyzes, as well as data obtained as a result of instrumental research methods are analyzed.
A blood test will detect signs of inflammation. A blood test for the determination of total immunoglobulin and antibodies to certain types of infectious agents is shown.
An effective diagnostic method aimed at confirming symptoms that are associated with disseminated encephalomyelitis is magnetic resonance imaging. Detected foci of inflammation, accompanied by edema, in rare cases – hemorrhage. If necessary, a contrast agent is introduced. It allows you to evaluate the stage of inflammation. An alternative to MRI is computed tomography.
Diagnosis of lesions of the spinal division is carried out using myelography.
For any signs of inflammation in the brain and spinal cord of the patient is hospitalized. Conducted drug therapy aimed at eliminating the cause, treatment of the disease and the removal of its symptoms. Physiotherapy methods are actively used for rehabilitation.
Antiviral therapy is prescribed for the diagnosis of “myalgic encephalomyelitis.” Antibiotics of the penicillin, cephalosporin group, aminoglycosides allow to cope with a bacterial infection.
To combat post-vaccination pathology using antihistamines.
Directly for the treatment of myelitis using glucocorticosteroids, as with other forms of scattered lesions demyelinating nature. Hormonal therapy is carried out for 1-1.5 months.
In severe situations or when it is impossible to use corticosteroids, plasmapheresis is prescribed. During the procedure, blood is purified from toxins, cell debris, antibodies. In the initial stages of the disease, vitamin therapy is carried out.
To prevent cerebral edema allows the use of Diacarb, magnesia.
In case of violation of urination, use catheters, washing with solutions that reduce the likelihood of infection. Constipation – an indication for regular use of enemas.
Reduce spasms, muscle tension will help muscle relaxants, such as Mydocalm. To improve cerebral circulation, nootropic drugs are prescribed – Piracetam, Nootropil.
For serious psycho-emotional disorders prescribe antidepressants, sedatives.
Massage is used to improve the blood supply, normalize cellular metabolism, relieve or, conversely, improve muscle tone.
With paralysis and paresis, transcranial magnetic stimulation is shown. Motor brain centers are activated, which leads to an improvement in the conductivity of impulses from neurons to organs and back.
Electric myostimulation affects the patient’s muscles, causing them to contract. As a result, metabolic processes are normalized, muscle tissue is restored, and the functioning of the nervous system improves.
Physical therapy is recommended for all patients with disseminated encephalomyelitis. Exercises are aimed at improving blood supply, muscle recovery. The complex of elements is selected depending on the human condition.
To reduce the tone of muscle tissue using warm baths with essential oils, mustard, turpentine. Water relaxes, improves blood flow, restores damaged nerve tissue.
Symptoms that indicate acute disseminated encephalomyelitis appear brighter in the first seven to ten days, then begin to fade. In most patients (70% of cases) full recovery occurs. Others have the following permanent effects: paresis, motor, sensory, vegetative disturbances, convulsions. Psycho-emotional disorders remain for a long time.
Fatal outcome is possible in the case of severe disease, the presence of comorbidities, for example, with the addition of upper respiratory tract infections, damage to the heart, internal organs.
Disseminated encephalomyelitis is important to recognize as quickly as possible. The symptoms of the disease at various stages resemble the symptoms of multiple sclerosis, meningitis, encephalopathy. Quickly initiated therapeutic measures will avoid serious consequences. Used for the treatment of drugs, medical rehabilitation is carried out.
The following sources were used to prepare the article:
Melnikov M. V., Boyko O. V., Lasch N. Yu., Popova E. V., Martynov M. Yu., Boyko A. N. Acute disseminated encephalomyelitis and multiple sclerosis: open questions of differential diagnosis on the example of a clinical case // Journal of Neurology and Psychiatry. Ss Korsakova – Special Issues. 2012; 112 (9): 52-58.